Why combine the two

When both the upper and lower eyelids are a concern, treating them together offers practical benefits: one anaesthetic, one recovery period and one round of time away from work and social plans. It also allows the surgeon to plan all four eyelids as a unit, balancing the upper lid crease and skin with the contour of the lower lids and the transition into the cheek.

When each is considered separately

If only the upper or only the lower lids are a concern, treating that area alone avoids surgery on tissue that does not need it. Combining procedures should follow the findings, not convenience. Many people seeking upper eyelid surgery have no meaningful lower lid issue, and vice versa.

The individual procedures are described in our guides to upper blepharoplasty candidacy and lower blepharoplasty candidacy.

What the assessment covers

A combined plan requires confirming that each eyelid warrants treatment independently. The assessment typically covers:

  • upper eyelid skin excess, crease position and eyelid height, including whether a droopy lid (ptosis) is present;
  • brow position, since a low brow can mimic upper eyelid heaviness;
  • lower eyelid support, laxity and position, which determine the safest lower lid technique;
  • the source of under-eye bulging, whether fat, fluid or skin;
  • tear film and dry eye history, because surgery on both lids can temporarily affect eye surface comfort; and
  • general health, medications and previous surgery or injectables around the eyes.

How the operation is planned

Upper blepharoplasty removes a planned amount of skin and, where appropriate, a little muscle or fat through an incision hidden in the natural crease. Lower blepharoplasty may be performed from inside the eyelid (transconjunctival) to address fat without a skin incision, or through a fine incision just below the lashes when skin also needs attention. Fat may be removed or repositioned to smooth the lid-cheek junction, and the outer corner of the lower lid may be supported to protect its position.

Combined surgery is usually performed under local anaesthetic with sedation, or under general anaesthetic, depending on the extent of the plan and your health.

Trade-offs to understand

A combined operation takes longer than either procedure alone and involves more healing surface. Swelling and bruising affect the whole eye area at once, and the eye surface may feel drier for a period, particularly while the lower lids settle.

On the other hand, the overall time to recovery is shorter than two separate operations spaced apart. Some patients prefer staging, for example treating the upper lids first and reassessing the lower lids later; others prefer a single recovery. Both are legitimate, and the right choice depends on your findings, health and circumstances.

Recovery

Swelling and bruising usually peak over the first two to three days and then improve steadily. Cold compresses, head elevation and lubricating drops or ointment are standard early aftercare. Skin stitches, if used, are typically removed in about a week. Many people feel comfortable being seen socially after two to three weeks, while the final result continues to refine over several months.

Report severe pain, increasing swelling on one side, or any change in vision promptly, as these can signal a complication that needs urgent attention. Our upper blepharoplasty recovery guide covers aftercare in more detail.

Risks

Risks include bleeding, infection, asymmetry, scarring, temporary or longer-lasting dry eye, difficulty closing the eyes fully at first, and changes in lower lid position. Careful assessment of lower lid support and eye surface health reduces these risks. Your surgeon should explain how they apply to your anatomy and how the plan protects eyelid function.

Questions to ask at your consultation

  • Does each eyelid meet the criteria for surgery on its own?
  • Which lower eyelid technique do you recommend, and why?
  • How does combining affect the risk and recovery compared with two separate operations?
  • Is my brow position contributing to upper eyelid heaviness?
  • What anaesthetic would you recommend for me?